Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | APRN.CNP.026184 | OH |
NPI | 1033742184 |
---|---|
Provider Name | Hamutyinei H Mamutse |
First Address | Pittsburgh, PA 15251-9500 |
Second Address | Fort Wayne, IN 46815-4631 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/02/2020 |
Last Update Date | 18/02/2020 |